Provider Demographics
NPI:1396798070
Name:CHERAYIL, JOSEPH M (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:CHERAYIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3925
Mailing Address - Country:US
Mailing Address - Phone:603-577-2045
Mailing Address - Fax:603-577-5644
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-2045
Practice Address - Fax:603-577-5644
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI46364Medicare UPIN
PA1014609390001Medicaid
PA7650336OtherCIGNA HMO/PPO
PAI46364Medicare UPIN
PA096396Medicare ID - Type UnspecifiedHGSA
PA11554120OtherCAQH ID#
PA2490436000OtherIBC - PC/KHPE
PA30027937OtherKEYSTONE MERCY
PA2490436000OtherAMERIHEALTH/INTERCOUNTY